Provider Demographics
NPI:1194403386
Name:FARNHAM, MIKAYLA ELAINE
Entity type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:ELAINE
Last Name:FARNHAM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MIKAYLA
Other - Middle Name:ELAINE
Other - Last Name:FARNHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:17335 PAGONIA RD STE 109
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711-6011
Mailing Address - Country:US
Mailing Address - Phone:407-602-5011
Mailing Address - Fax:
Practice Address - Street 1:17335 PAGONIA RD STE 109
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-6011
Practice Address - Country:US
Practice Address - Phone:407-602-5011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-07
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician